PASRR - III. Mental Illness

  1. Specific Conditions. An individual is considered to have a serious mental illness if s/he meets the following requirements of diagnosis, level of impairment and duration of illness:
    1. Diagnosis. The individual has a major mental disorder diagnosable under the DSM-3-R. This mental disorder is:
      1. a schizophrenic, mood, paranoid, panic or other severe anxiety disorder; somatoform disorder; personality disorder; other psychotic disorder; or another mental disorder that may lead to a chronic disability; but
      2. not a primary diagnosis of dementia, including Alzheimer's disease or a related disorder, or a non-primary diagnosis of dementia unless the primary diagnosis is a major mental disorder.
    2. Level of impairment. Within the past 3 to 6 months the disorder has resulted in functional limitations in major life activities that would be appropriate for the person's developmental stage. An individual typically has at least one of the following characteristics on a continuing or intermittent basis:
      1. interpersonal functioning. the person has serious difficulty interacting appropriately and communicating effectively with other persons, has a possible history of altercations, evictions, firing, fear of strangers, avoidance of interpersonal relationships and social isolation; and/or
      2. concentration, persistence, and pace: the person has serious difficulty in sustaining focused attention for a long enough period to permit the completion of tasks commonly found in work settings or in work-like structured activities occurring in school or home settings, manifests difficulties in concentration, inability to complete simple tasks within an established time period, makes frequent errors, or requires assistance in the completion of these tasks; and/or
      3. adaptation to change. the person has serious difficulty in adapting to typical changes in circumstances associated with work, school, family, or social interaction; manifests agitation, exacerbated signs and symptoms associated with the illness, or withdrawal from the situation; or requires intervention by the mental health or judicial system.
    3. Recent treatment. The treatment history indicates that the person has experienced at least one of the following:
      1. psychiatric treatment more intensive than outpatient care more than once in the past 2 years (e.g., partial hospitalization or inpatient hospitalization); or
      2. within the last 2 years and due to the mental disorder,an episode of significant disruption to the normal living situation, for which supportive services were required to maintain functioning at home, or in a residential treatment environment, or which resulted in intervention by housing or law enforcement officials.
  2. Dementia. An individual is considered to have dementia if there is a primary diagnosis of dementia, as described in the DSM, or a non-primary diagnosis of dementia unless the primary diagnosis is a major mental disorder as defined in Section III.a.i. above. (Agitated dementia with a suspicion of mental illness should be noted on the Level 1 Screen and sent to APS Healthcare, the Department's current agent, for review).
  3. Specialized Services. Specialized services are those that are provided in addition to the routine care provided by an NF, and that result in the continuous and aggressive implementation of an individualized plan of care for mental illness. DHHS considers specialized services to be appropriate in an NF when they:
    1. are developed and overseen by an interdisciplinary team that includes a physician and mental health professionals, and, as appropriate, other professionals; and
    2. prescribe specific therapies and activities supervised by trained mental health personnel; and
    3. are directed towards diagnosing and reducing the person's behavioral symptoms, improving the level of independent functioning, and achieving a functioning level that permits reduction in the intensity of mental health services at the earliest possible time.
      The prescribed therapies and activities in the individualized care plan may include, but are not limited to the services of a psychiatrist, nurse practitioner, psychologist or other qualified mental health professional, psychological testing or evaluation, occupational therapy testing or evaluation, psychotherapy, medication education, crisis planning and intervention services, day hospitalization or acute care hospitalization and case management necessary to coordinate the services described in the plan.
  4. Services of Lesser Intensity than Specialized Services. The NF must provide mental health services that are of a lesser intensity than specialized services to all residents who need the lesser services.
  5. Specialized Community NFs (geropsychiatric NF level of care). DHHS supplements the services of three NFs in the state, to provide more intensive specialized services than would be provided at a community NF. Contact APS Healthcare to discuss this option.